JFA Purple Orange - ACT Office of the Senior Practitioner - Interim Report March 2017

Minimising and Eliminating Restrictive Practices.

A Consultation for the ACT Government

Acknowledgment

We gratefully acknowledge the assistance of the following persons who contributed ideas and perspectives as part of a co-design process for the development of this report.

Christina Ryan, CEO, Advocacy For Inclusion Fiona May, Chief Executive Officer, ADACAS Jan Kruger, Director, Imagine More

Robert Altomare, Executive Officer, PWD ACT Steve Fox, Manager, NDS in ACT

Simon Viereck, Executive Officer, Mental Health Community Coalition ACT Purity Goj, Program Manager, Mental Health Consumer Network ACT Charlie Richardson, Mental Health Community Coalition ACT

Richard Bruggemann, Senior Practitioner, Disability SA Sue Salthouse, WWDACT

Susan Helyar, Director, ACTCOSS

Agency details

JFA Purple Orange 104 Greenhill Road

Unley SA 5061 AUSTRALIA

Telephone: + 61 (8) 8373 8333

Fax: + 61 (8) 8373 8373

Email: admin@purpleorange.org.au Website: www.purpleorange.org.au

Facebook: www.facebook.com/jfapurpleorange

JFA Purple Orange is a non-government, social profit organisation. Anchored on dialogue with people living with disability, their families, service providers, government and other stakeholders, we seek to identify policy and practice that has the prospect of advancing peoples chances of a good life. Our work is anchored on the principles of Personhood and Citizenhood. Our work includes research, evaluation, capacity building, consultancy, and hosted initiatives.

ISBN: 978-0-9804509-4-1March 2017.

Contents

Background and Summary4The structure of this report9Evaluation of data: findings from Phase 2 consultations9Main themes: What are the biggest issues and concerns relating to restrictive practices in the ACT and the establishment of an Office of the Senior Practitioner?9A lack of awareness and consistency of what constitutes restrictive practices10The use of restrictive practices in Mental Health settings across the ACT11A lack of capacity within the sector for managing behaviour and its etiology12The need for leadership that drives a strategy and culture change regarding restrictive practices across the sector13A lack of current reporting of the use of restrictive practices and any associated long- term data15Differing opinions regarding the use of restrictive practices16Possible solutions to minimising and eliminating restrictive practices in the ACT17A strategy around training and awareness-raising around restrictive practices17A focus on training and awareness-raising strategies within educational institutes ... 18A capacity-building model to increase knowledge and skills across the sector regarding the use of restrictive practices19Considerations for training and capacity-building21Design Features and Recommendations for an ACT Office of the Senior Practitioner22Considerations in establishing an Office of the Senior Practitioner for the ACT25Conclusion26Appendix 1: Copy of online survey questions28

1. Background and Summary

The purpose of this paper is to report on a community consultation that is being led by JFA Purple Orange on how an Office of the Senior Practitioner might operate in the ACT. A discussion paper released in January 2017 gives an overview of what is meant by restrictive practices, the extent to which such practices are an issue in the ACT, and how these issues might be addressed through an Office of the Senior Practitioner.

From late January to early March 2017, a range of opportunities were offered for people to give their views about this topic. This report provides an overview of the findings, opinions and recommendations that have emerged through Phase 2 consultations. This report also provides a set of possible features and components that could be considered should adoption and design of an Office of the Senior Practitioner be undertaken by the ACT government.

For the purpose of this project the definition of restrictive practices offered by the Government of South Australia has been utilised:

Restrictive practices refer to any practice, device or action that removes or restricts another persons freedom, movement or ability to make a decision. This includes detention, seclusion, exclusion, aversive restraint, chemical restraint, physical restraint, mechanical restraint, environmental restraint and psycho-social restraint. Restrictive practices do not include therapeutic or safety devices/practices, where the device or practice is being used for its intended purpose and the person is not resisting or objecting to its use.[footnoteRef:1] [1: SA Government DCSI Safeguarding People with Disability Overarching Policy DIS/366 POL-SER-002-2013]

Restrictions can include (but are not necessarily limited to):

mechanical, such as devices that limit a persons movements (and this includes the removal and/ or disengagement of mechanical supports that assist the persons movements)

seclusion, such as the sole confinement of a person at any time in any room where the doors and windows cannot be opened by that person

environmental, such as preventing free access to all parts of a persons environment or house (for example locking the refrigerators)

social, such as the imposition of sanctions that restrict the persons access to relationships/opportunities they value

chemical, such as medications that blunt the persons emotions, cognition, and motor activity

physical, such as holding or pinning down by another person

psycho-social restraints, such as power control strategies[footnoteRef:2] which might include threats, intimidation, fear, coercion, discipline, or retaliation [2: Power-control strategies are defined in South Australias Safeguarding People with Disability Restrictive Practices Policy as the use of power-control strategies to influence a persons behaviour. This includes but is not limited to directing the persons behaviour through voice tone, commands or threats and the use of punishment, including ignoring the person and withholding basic human rights, such as positive social interaction, personal belongings or a favoured activity.]

organisational, such as excluding the person from activities, and restrictions to the person's choice

communication restraint, such as switching off someones communication device

decision making restraint, such as failing to provide options for supported decision making

While taking action to avert a clear and present risk of harm is understandable, there are a number of problems with the imposition of restrictive practices. These include (but are not necessarily limited to):

the negative consequences the restrictive practice by its nature can have on the persons progress towards good life chances, their general well-being, physically and psychologically including the impact on self-esteem

restrictive practices that are focused on behaviour suppression as opposed to supporting genuine positive behaviour change

restrictive practices that are focused on a negative reinforcement paradigm (the use of punishment to extinguish an unwanted behaviour, as opposed to positive reinforcement paradigms that focus on rewarding the emergence of behaviour choices that can advance the persons life chances)

restrictive practices that are inadequate in terms of their conceptualisation and implementation

restrictive practices that are inadequate in terms of a clearly defined timeframe and process for review

restrictive practices that constitute an assault on the persons human rights

restrictive practices that are crafted and/or executed by staff with inadequate skills and perspective.

It is recognised that the use of restrictive practices may not always be intentional but that actions taken, or not taken, inadvertently have the effect of restricting a persons preferences and actions, and/or contravening their rights. The person using the restrictive practice may argue that there is no malicious intent and that it is just the way that things are done. However, this is not an adequate defence for the continuation of such practices.

A targeted set of questions was formed for use in Phase 2 of this consultation project, alongside a similar set of questions that formed an online survey. Some consultations used all of these questions whereas others were of a workshop format and asked participants to identify issues related to the use of restrictive practices across the ACT sector and to brainstorm possible solutions to these issues. Appendix 1 provides a copy of the survey questions whilst Box 1 outlines examples of the questions used in telephone and face-to-face consultations which occurred between January and March 2017.

Consultation questions: face-to-face and telephone consultations

1. Do you think the ACT Government should set up an Office of the Senior Practitioner to help ensure that restrictive practices are kept to a minimum, and ideally eliminated, in the ACT?

Who could run this?

2. Do you think it would be a good idea for there to be a register of every person who is being subjected to restrictive practices?

How could that register work, including reporting?

Who could run the register?

3. What should be the priorities in a strategy to raise awareness of the problems of restrictive practices?

Do you think an ACT OSP could do this or do you think there is some other ACT or national agency that could do this?

4. How might an ACT OSP build capacity for best practice within the health, education and community services sectors, so that